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Running head: BEHAVIORAL THERAPY FOR INCONTINENCE
Behavioral Therapy as an Adjunct to Drug Therapy in Treating
Urinary Incontinence: A Critical Appraisal Topic
Rebecca J Jochim RN, FNPs
University of Mary
Behavioral Therapy as an Adjunct to Drug Therapy in Treating Urinary Incontinence
A Critical Appraisal Topic
Date: March 6, 2014
Case Presentation
75 year old female presents to the clinic with complaints of increased urinary frequency and incontinence that has become worse over the past several months. Using increased number of incontinence products throughout the day. Denies pain or burning with urination, denies flank pain, fever, chills, no increased urine odor or cloudiness. Urinalysis negative for urinary tract infection. Reports increased feeling of urgency and incontinence with coughing, sneezing or straining.
Clinical Question
Does behavioral therapy improve urinary incontinence symptoms in women who are already receiving drug treatment?
Appraised Articles
1.Burgio, K., Kraus, S., Borello-France, D., Chai, T., Kenton, K., Goode, P., Xu, Y., & Kusek, J.
(2010).The effects of drug and behavior therapy on urgency and voiding frequency.
Internatioal Urogynocology Jornal, 21(6), 711-719. doi: 10.1007/s00192-010-1100-x.
2. Dumoulin, C., & Hay-Smith, J. (2010). Pelvic floor muscle training versus no
treatment, or inactive cotnrol treametns, for urinary incontinence in women (review). Cochrane
Database of Systematic Reviews, (1), doi: 10.1002/14651858.CD005654
Study #1
Strengths
Two-stage, randomized controlled trial with large sample size (n 307). Participants were assessed and inclusion was determined by using a standardized index score utilizing the Medical, Epidemiological, and Social Aspects of Aging Questionnaire (MESA). Participants were randomly assigned to either a drug therapy only group or drug therapy combined with behavioral therapy.
Weakness/ limitations
Only half of the participants in this study completed useable urgency ratings at both points of measurement and the members in this group reported milder urgency symptoms at baseline compared to those members with missing data. It was also found that those women who were in the drug only treatment group also received some components of the behavioral treatment program[RJ1], which may have minimized differences in the two groups.
Summary
Both drug therapy alone and in combination with a behavioral therapy program improved incontinence symptoms in women with predominant urge incontinence. However, for women with only mild urgency symptoms, no added benefit was seen with the addition of behavioral therapy on subjective urge incontinence but improved voiding frequency was seen. Women who had milder incontinence at baseline had better outcomes overall with the addition of a behavioral therapy program.
Study #2
Strengths
Level 1 systematic review of randomized or quasi-randomized trials in women with stress, urge or mixed urinary incontinence. Trials were independently assessed and data was processed using the Cochrane Handbook. A large sample size of 14 trials including 836 women were selected.
Weaknesses/limitations
There was a large variation in the interventions used from study to study and a wide variation in the populations studied. These variations in incontinence type, training and outcomes measured made statistical analysis across these studies difficult.
Summary
The author’s findings support the use of pelvic floor muscle training (PFMT) should be included in first-line conservative management for women with stress, urge and mixed urinary incontinence. The greatest benefit was seen in women who had stress urinary incontinence alone and participated in a PFMT treatment program for at least three months.
Bottom line
With findings that support the use of pelvic floor training/behavioral therapy in level 1 and 2 evidence, there is strong support for their use in urinary incontinence in women both alone and in addition to drug therapy. There is little risk of adverse effects with these programs so there is little to no risk to patients by including behavioral therapy/PFMT in education about urinary incontinence.
Education about PFMT and behavioral interventions should be included in counseling patients when addressing urinary incontinence or when prescribing drug therapy for urinary incontinence.
References
Burgio, K., Kraus, S., Borello-France, D., Chai, T., Kenton, K., Goode, P., Xu, Y., & Kusek, J.
(2010). The effects of drug and behavior therapy on urgency and voiding frequency.
International Urogynocology Journal, 21(6), 711-719. doi: 10.1007/s00192-010-1100-x.
Dumoulin, C., & Hay-Smith, J. (2010). Pelvic floor muscle training versus no treatment, or
inactive controltreatments, for urinary incontinence in women (review). Cochrane
Database of Systematic Reviews, (1), doi: 10.1002/14651858.CD005654
[RJ1]??? comma here after program